National Sleep Awareness Month: Sleepwalking and other parasomnias

MARCH IS NATIONAL SLEEP AWARENESS MONTH

Comedian Mike Birbiglia (pictured, right) knows a thing or two about sleep disorders.

In fact, his career took a positive swing upward after he released his biographic film, Sleepwalk With Me, back in 2012.

Since then, he's become a celebrated spokesperson for certain sleep disorders that fall under the category of Parasomnias.

He suffers from REM Behavior Disorder (see below). Birbiglia has made it a priority to use his line of work as an entertainer to raise awareness about this dangerous form of parasomnia.

After all, it ultimately landed him in the hospital before he learned what was wrong and sought treatment.

What is Parasomnia?

Parasomnia refers to any kind of abnormal or unusual behavior that occurs while a person sleeps.

What kinds of sleep-related behaviors are considered parasomnias?

There are two categories of parasomnia: those which happen in nonREM sleep, and those which happen in REM sleep.

REM stands for "rapid eye movement" and marks the stage of sleep when you are most likely to dream.

NON-REM PARASOMNIAS

SLEEPWALKING

Also called somnambulism, this common behavior is seen is people who are asleep and yet participate in any number of physical tasks and activities. Some people may enact these behaviors in their beds, while others will rise from bed and walk about, doing unusual things like painting imaginary fences, moving laundry from one room to the next, climbing onto countertops, or even leaving one's home to go for a jog (while in their pajamas and completely asleep).

Sleepwalkers typically don't know they are sleepwalking, and if awakened, they will be confused and disoriented and have no recall of their behavior. (Awakening a sleepwalker, by the way, is okay as long as you are gentle and help them back into bed.)

Most sleepwalking happens to children between the ages of 3 and 18, and it's considered harmless unless the activities place sleepwalkers in harms' way (as in the case of a person who climbs objects, leaves the house, or tries to operate equipment).

NIGHT TERRORS

Also known as sleep terrors, these can resemble extreme nightmares but there is one key difference: night terrors take place during nonREM sleep, usually earlier in the night, and they may also include some sleepwalking behavior.

People who have night terrors are usually inconsolable during the event, but once awake, they aren't likely to even remember what terrified them during that time. Children mostly experience night terrors, but these can happen in adults, too.

NOCTURNAL SLEEP-RELATED EATING DISORDER (NS-RED)

This is a form of sleepwalking which involves rising to prepare and eat food. However, the food items being prepared and eaten may not be considered safe to consume, such as raw meats or large quantities of ice cream.

This can be a dangerous form of sleepwalking as it may involve the handling of sharp objects like knives or heat-producing or electronic appliances, such as stove tops, ovens, or toasters.

The person experiencing NS-RED is completely unaware of this nightly behavior and may experience mysterious weight gain or daytime problems with digestion and metabolism. Often the only way they know they had an episode is the following morning, when they find kitchen utensils and food left out on the counter that wasn't there when they went to bed.

It's important to note that NS-RED qualifies for treatment both as a sleep disorder and as an eating disorder.

SEXSOMNIA

Yet another form of sleepwalking, this somnambulist behavior during nonREM sleep involves engagement in sexual acts (masturbation, fondling, intercourse, even sexual assault) while they are fully asleep. They awaken with no memory of the behavior.

REM PARASOMNIAS

NIGHTMARES

We've all had scary dreams that are vivid, with disturbing content. These occur most often in children, but anyone can have them. They occur during REM sleep. If they are scary enough to awaken the person having the nightmare, they will usually have a detailed recollection of their scary dream's content.

Nightmares are dreams with vivid and disturbing content. They are most common in children during REM sleep, but they can happen to adults in this sleep stage as well. When a person experiencing frequent nightmares over several days or weeks, their sleep may begin to suffer because they may be afraid to even fall asleep. Fortunately, they could seek help from a sleep physician and arrive at a diagnosis of Nightmare Disorder, which allows them certain treatment options so they can get the sleep they need.

SLEEP PARALYSIS

This scary phenomenon happens while falling asleep or upon awakening: the sudden inability to move or speak. Though temporary (only lasting up to two minutes), the experience can be terrifying.

Sleep paralysis occurs as a result of faulty neurological transitioning between sleep and wakefulness, especially to and from REM sleep.

During REM-stage sleep, the body is temporarily paralyzed from the neck down. This is normal; however, mixed central nervous system signals during awakening may allow for conscious wakefulness while the body is still in REM paralysis.

Sleep paralysis, because it happens to and from wakefulness, may be accompanied by auditory or visual hallucinations as well, making it an even scarier experience.

It can happen to people of all ages and is fairly common among normal, healthy sleepers, though it's usually experienced more commonly by people with narcolepsy or sleep apnea.

REM BEHAVIOR DISORDER (RBD)

This sleep disorder resembles sleepwalking except for one key difference: it takes place during REM sleep, and it involves the enactment of one's dream content in the physical environment. Upon awakening, the person with RBD will have full recollection of their dream scenario. It is often vivid, disturbing, and even violent.

What's critical to note here is that, as described above, the body during REM sleep is meant to be paralyzed.

Scientists think this is because the brain wants to shut down the body so that it doesn't act out dream content as a safety measure. However, people with RBD have a faulty "switch" in their brainstem that doesn't create a gate blocking nerve impulses from the brain to the muscles of the body as it should.

RBD happens mostly to adults and is often (though not always) associated with other neurological conditions such as Lewy body dementia, Parkinson's disease, or multiple system atrophy. It is thought that military veterans with PTSD may be more prone to RBD, as well. It's a dangerous condition as it not only creates an unsafe situation for the person experiencing the sleep disorder, but for their sleepmates, roommates or others as well.

What is Mike Birbiglia's story?

"Comedian Mike Birbiglia was on tour in Washington state when he had a dream that a guided missile was heading toward his hotel room. In his dream—and in real life—Birbiglia decided to jump out the window of his hotel room. He was staying on the second floor."

This was just one in a series of disastrous behaviors Birbiglia enacted while suffering what he thought was sleepwalking during the early days of his comedy tours. Ultimately, the trip to the hospital following the crash through the hotel window forced him to seek treatment, and he discovered he had RBD. The comic, whose film about RBD earned both nominations and awards, is now (thankfully) treated for his dangerous condition.

Safety is perhaps the biggest reason why any parasomnia behavior involving mobilized behavior should be observed, diagnosed and treated, for both the safety of the person experiencing the parasomnia and for those around them who might be affected by their behavior.

Parasomnias may also signal other physical or mental health concerns that have yet to be identified. For instance, night terrors in an adult may suggest underlying post-traumatic behavior or generalized anxiety that needs to be addressed.

Some parasomnias don't require treatment. Sleepwalking in children usually subsides by adulthood. Sleep paralysis, while scary, is usually a self-limiting problem. Night terrors are often more traumatizing for parents, roommates, and bedmates than they are for those experiencing them. If you experience sleepwalking, sleep paralysis or night terrors yourself, or witness these events in loved ones, and you feel they are too serious to ignore, seek help from a medical professional (better safe than sorry).